ibo’s programmatic review of the 2006 budget ... - nyc ibo program bu… · (dohmh) new york city...

January 2006

IBO’s Programmatic Review of the 2006 Budget as of the November Financial Plan

Department of Health and Mental Hygiene

(DOHMH)

New York City Independent Budget Office Ronnie Lowenstein, Director George Sweeting, Deputy Director Preston Niblack, Deputy Director Frank Posillico, Deputy Director 110 William St., 14th Floor . New York, NY 10038 Tel. (212) 442-0632 . Fax (212) 442-0350 e-mail: [email protected] . http://www.ibo.nyc.ny.us

INDEPENDENT BUDGET OFFICE JANUARY 2006 2

Introductory Note IBO’s programmatic reviews of the 2006 budgets of selected city agencies are intended to assist the public and elected officials better understand the allocation of budgetary resources to city services by presenting agency budgets in a way that is more closely aligned with the actual programs, functions, and services of major city agencies. The current city budget presentation inhibits understanding and participation in three ways. First, agency budgets, organized into broad units of appropriation, do not easily allow users to understand how much money is being spent from one year to the next on the programs and services that citizens and their elected representatives care about—programs such as job training, childhood lead-poisoning prevention, HIV/AIDS prevention and treatment, after-school programs, immigrant services, affordable housing construction, and recreation programs. Second, budget proposals are presented in terms of Financial Plan changes, rather than in terms of year-to-year comparisons. A proposed cut, or “PEG,” of $1 million in a program is presented without information on how much was previously projected for spending on that program in previous Financial Plans, and whether the $1 million “cut” would leave spending lower, higher, or the same as previous years’ spending levels. This presentation often manifests itself in annual debates over “hidden cuts” and what has been “baselined” in the Financial Plan. This manner of presenting the budget makes it difficult to understand the consequences for agency programs of budgetary decisions. Finally, it is virtually impossible to link spending decisions to program results. Although at one time the city was a trailblazer in performance reporting, the lack of linkage between performance data reported in the Mayor’s Management Report and elsewhere, and clear spending information, makes it difficult for citizens, elected officials, and even agency managers to know what they are getting for their money and to evaluate alternatives. Our programmatic budget presentations integrate existing performance data from the Mayor’s Management Report, Capstat, and other sources produced by the Mayor’s office alongside spending figures, to provide a unified presentation of both spending and performance. Our goal in preparing these budget reviews has been to hew as closely as possible to how the agencies themselves present their organization, programs, and services, on their official Web sites and other sources, including using the agencies’ own language to describe programs in most cases. While we have sought, and in most cases received, considerable input from agencies in the preparation of the program budget reviews, our presentations are not necessarily how the Mayor’s budget office or the agencies themselves would present their budgets, were they to do so in programmatic terms. Nonetheless, we think that our presentations can be instructive and point the way toward how to improve understanding of the city’s budget in a way that enhances public participation in the budget process. IBO will periodically update our program budgets. We will continue to separately issue our analysis of the Preliminary Budget, including of selected agency budgets, as we have every year as required by City Charter section 246. We welcome your comments or questions, which you may direct to IBO at (212) 442-0632, or by e-mail to [email protected].


Department of Health and Mental Hygiene MISSION The mission of the Department of Health and Mental Hygiene (DOHMH) is to protect and promote the health and mental health of all New Yorkers, to support the recovery of individuals with mental illness and chemical dependencies, and to promote the realization of the full potential for individuals with mental retardation and developmental disabilities. AGENCY DESCRIPTION The Department of Health and Mental Hygiene provides mental health services, mental retardation and developmental disabilities services, chemical dependency prevention and treatment, and Early Intervention services to developmentally delayed infants and toddlers. DOHMH’s community-based services include three District Public Health Offices, seven walk-in immunization clinics, 10 TB centers, 10 clinics treating sexually transmitted diseases (STD), and health and mental health services in the City’s adult correctional facilities. FIVE-YEAR EXPENDITURE TRENDS BY PROGRAM AREA Department of Health and Mental Hygiene Dollars in millions 2002** 2003 2004 2005 2006

Actual

Expenses Actual

Expenses Actual

Expenses Actual

Expenses

Current Modified Budget

Spending by Program Area Disease Prevention and Treatment $ 256.3 $ 261.8 $ 278.8 $ 278.2 $ 313.3 Environmental Health Services 63.2 53.1 57.1 63.2 73.5 Personal and Community Health Services 100.8 98.5 104.4 123.3 131.5 Health Insurance and Health Care Access 165.7 169.7 156.3 154.9 156.9 Mental Health Services 635.2 726.7 768.5 714.8 809.3 Office of the Chief Medical Examiner 48.0 52.6 39.4 39.4 50.1 Administration 73.2 66.0 66.2 69.7 72.0

TOTAL 1,342.5 1,428.5 1,470.6 1,443.5 1,606.5 Spending by Object Personal Services $ 245.1 $ 240.9 $ 266.8 $ 280.0 $ 319.7 OTPS 1,097.4 1,187.5 1,203.8 1,163.5 1,286.8 Full-time Personnel* 3,160 3,253 3,693 3,788 3,867 Capital Commitments $ 44.0 $ 54.5 $ 32.5 $ 51.3 $ 150.6 SOURCE: IBO. NOTES: *Fulltime personnel: June 30 actual for 2002 through 2005; budgeted positions for 2006. Actual fulltime staffing as of Nov 30 for 2006. **Prior to 2003, public health services were delivered by two separate agencies, the Department of Health and the Department of Mental Health, Mental Retardation, and Alcoholism Services. In 2003, these two departments were merged to create the Department of Health and Mental Hygiene. The budget figures used here for 2001 and 2002 represent a merger of the two departments' expenditures.

Department of Health and Mental Hygiene


PROGRAM CHART

Program Area Programs Disease Prevention and Treatment HIV/AIDS Prevention and Treatment STD Prevention and Treatment Tuberculosis Control Epidemiology Immunization Bioterrorism Preparedness World Trade Center Health Registry General Disease Prevention and Treatment Environmental Health Services General Environmental Health Veterinary and Pest Control Services Lead Poisoning Prevention and Treatment Asthma Initiatives Environmental Sciences and Engineering Poison Control Food Safety and Community Sanitation Personal and Community Health Services School Health Services General Personal and Community Health

Services Day Care Monitoring Maternal and Child Health Tobacco Control Health Insurance and Health Care Access Correctional Health Services Health Insurance and Medicaid Managed Care Oral Health Services Mental Health Services Early Intervention Program General Mental Health Chemical Dependency Prevention and

Treatment Office of the Chief Medical Examiner

Department of Health and Mental Hygiene Disease Prevention and Treatment


PROGRAM AREA: DISEASE PREVENTION AND TREATMENT The Division of Disease Control safeguards the health of New Yorkers through the identification, monitoring, treatment, prevention, and control of infectious diseases. The Division is also charged with protecting the health of city residents during emergencies—an effort that includes bioterrorism preparedness and emergency management.

Disease Prevention and Treatment Dollars in thousands

2004 Actual

Expenses

2005 Actual

Expenses

2006 Current Modified Budget

Spending $278,811 $278,179 $313,252

Personal services 76,700 81,003 88,620 Other than personal services 202,111 197,176 224,632

Funding City n.a. n.a. $51,359 Intracity n.a. n.a. 555 Federal n.a. n.a. 226,667 State n.a. n.a. 30,967 Other Categorical n.a. n.a. 3,704 Full-time Positions 1,356 1,341 1,344 Programs HIV/AIDS Prevention and Treatment $188,875 $180,765 $185,504 STD Prevention and Treatment 13,719 13,746 12,942 Tuberculosis Prevention and Treatment 35,389 32,107 43,847 Epidemiology 17,873 21,367 23,173 Immunization 10,375 8,885 10,958 Bioterrorism Preparedness 9,843 20,139 34,739 World Trade Center Health Registry 1,740 925 1,265 General Disease Prevention and Treatment 998 245 825 SOURCE: IBO. NOTE: Full-time personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006.

Performance Results: See program sections.



HIV/AIDS Prevention and Treatment The Bureau of HIV/AIDS performs HIV and AIDS surveillance, participates in community planning through the NYC HIV Prevention Planning Group, and oversees contracts for HIV prevention, care, and housing in New York City.

2004 2005 2006 Actual Actual Current

HIV/AIDS Prevention and Treatment Dollars in thousands

Expenses Expenses Modified Budget

Spending $188,875 $180,765 $185,504 PS 15,412 14,878 17,036 OTPS 173,463 165,887 168,467 Funding City n.a. n.a. $15,156 State n.a. n.a. 11,740 Federal n.a. n.a. 158,498 Other Categorical n.a. n.a. 109 Full-time Positions 286 271 278SOURCE: IBO. NOTE: Full-time personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006.

Performance Results: HIV/AIDS Prevention and Treatment Performance Statistics Type of Indicator 2002 2003 2004 2005 Persons diagnosed, living, and reported with HIV/AIDS (calendar year) Demand 78,880 82,810 88,479 95,451 Clients enrolled in HIV/AIDS health and supportive services Demand 74,100 80,000 85,100 94,400 Laboratory tests for HIV performed by DOHMH Output 120,720 121,440 116,820 90,113 Average turnaround time for tests with a negative HIV result (in days) Efficiency 1.1 1.0 1.0 1.1 Average turnaround time for tests with a positive result (in days) Efficiency 2.1 2.1 2.1 2.0 Number of HIV rapid tests conducted Output n.a. n.a. 6,640 51,673

SOURCE: Mayor’s Management Report.



STD Prevention and Treatment The Bureau of Sexually Transmitted Disease (STD) Control monitors STD trends throughout the city, promotes behaviors that prevent STDs, and conducts research to gather new information about risk behaviors, prevention, and treatment. The Bureau also promotes STD diagnosis and encourages counseling and partner notification. DOHMH operates 10 full-service STD clinics which, in addition to STD testing and treatment, provide free emergency contraception, hepatitis C testing, and vaccination services for hepatitis A and B.

2004 2005 2006

Actual Actual Current

STD Prevention and Treatment Dollars in thousands


Spending $13,719 $13,746 $12,942 PS 10,842 11,514 10,771 OTPS 2,877 2,232 2,172 Funding City n.a. n.a. $3,873 State n.a. n.a. 1,635 Federal n.a. n.a. 6,242 Other Categorical n.a. n.a. 1,137 Intracity n.a. n.a. 55 Full-time Positions 154 162 162SOURCE: IBO. NOTE: Full-time personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006.

Performance Results: STD Prevention and Treatment Performance Statistics Type of Indicator 2002 2003 2004 2005 Reported STD cases, citywide Demand 54,997 61,341 57,877 54,502 STD cases treated by DOHMH Output 45,543 45,368 44,231 40,874 STD clinic visits Demand 67,088 70,114 70,669 67,417




Tuberculosis Control The Bureau of Tuberculosis Control’s mission is to prevent the spread of tuberculosis (TB) and eliminate it as a public health problem in New York City. To achieve this, the Bureau attempts to identify all individuals with suspected or confirmed TB disease and ensure their appropriate treatment.

2004 2005 2006


Tuberculosis Prevention and Treatment Dollars in thousands


Spending $35,389 $32,107 $43,847 PS 21,348 20,121 20,707 OTPS 14,041 11,986 23,140 Funding City n.a. n.a. $15,565 State n.a. n.a. 10,444 Federal n.a. n.a. 15,337 Other Categorical n.a. n.a. 2,002 Intracity n.a. n.a. 499 Full-time Positions 394 351 337SOURCE: IBO. NOTE: Full-time personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006.

Performance Results: Tuberculosis Control Performance Statistics* Type of Indicator 2002 2003 2004 2005 New tuberculosis cases reported and confirmed, citywide Demand 1,261 1,084 1,140 1,039 Patients who completed treatment for active tuberculosis (%) Outcome 91.3% 91.0% 91.1% 91.0% Number of visits to DOHMH TB clinics Demand 134,834 134,421 124,695 122,239 Percentage of all confirmed TB patients treated by DOHMH Outcome 55.7% 57.4% 71.7% 73.0% Percentage of all high-risk TB patients treated and monitored by DOHMH Outcome 59.1% 59.7% 63.1% 78.0% SOURCE: Mayor’s Management Report. *NOTE: All indicators are on a calendar year basis.



Epidemiology The Division of Epidemiology provides epidemiologic support to DOHMH programs and external organizations to improve monitoring and delivery of public health services in New York City. The Division’s primary goals are four-pronged: to strengthen the DOHMH’s epidemiological capacity through research, consultation to programs, and public health and technical training; enhance surveillance activities to ensure timely and focused response to ongoing public health issues, as well as public health emergencies; collect, analyze, and disseminate vital statistics and other data; develop agency-wide training programs in epidemiology, emergency preparedness, and other public health areas.

2004 2005 2006


Epidemiology Dollars in thousands


Spending $17,873 $21,367 $23,173 PS 13,425 15,014 16,698 OTPS 4,448 6,353 6,475 Funding City n.a. n.a. $14,948 State n.a. n.a. 6,715 Federal n.a. n.a. 1,214 Other Categorical n.a. n.a. 296 Full-time Positions 247 257 270SOURCE: IBO. NOTE: Full-time personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006. Performance Results: Epidemiology Performance Statistics Type of Indicator 2002 2003 2004 2005 Average response time for mailed requests for birth certificates (days) Efficiency 3 5 7 4 Average response time for mailed requests for death certificates (days) Efficiency 6 8 10 7




Immunization The Bureau of Immunization operates clinics, monitors school entrance vaccination rates, and maintains the Citywide Immunization Registry. Citywide influenza vaccination efforts include free vaccinations at 6 walk-in immunization clinics and hundreds of senior centers.

2004 2005 2006


Immunization Dollars in thousands


Spending $10,375 $8,885 $10,958 PS 6,165 6,444 6,861 OTPS 4,209 2,441 4,097 Funding City n.a. n.a. $1,795 State n.a. n.a. 314 Federal n.a. n.a. 8,849 Full-time Positions 123 128 128SOURCE: IBO. NOTE: Full-time personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006. Performance Results: Immunization Performance Statistics Type of Indicator 2002 2003 2004 2005 Immunizations given at DOHMH walk-in clinics Output 92,351 89,077 85,065 116,206 Percent of students entering the school system completely immunized Outcome 90% 91% 90% 89%




Bioterrorism Preparedness Recognizing the need for coordination of emergency response within the agency and between the agency and its partners, a new Bureau of Emergency Management was formed in 2002. The Bureau conducts emergency preparedness education for DOHMH staff, develops emergency communications systems, provides logistical support for planning as well as crisis-management and emergency-response services.

2004 2005 2006


Bioterrorism Preparedness Dollars in thousands


Spending $9,843 $20,139 $34,739 PS 8,205 12,228 15,523 OTPS 1,638 7,911 19,216 Funding Federal n.a. n.a. $34,690 Other Categorical n.a. n.a. 49 Full-time Positions 142 160 159SOURCE: IBO. NOTE: Full-time personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006.

Performance Results: No reported performance statistics.



World Trade Center Health Registry DOHMH and the federal Agency for Toxic Substances and Disease Registry received a grant from the Federal Emergency Management Agency (FEMA) to design and maintain a World Trade Center Health Registry for persons most directly exposed to the disaster site. DOHMH has overall responsibility for the development, start-up, enrollment, and maintenance of the Registry. The Registry is designed to: identify and register individuals who were in close proximity to the disaster site on 9/11 or who worked in the rescue, recover, or clean-up efforts; follow the health of those individuals over the next 10 years to track and compare changes in their physical and mental health with people who were not exposed; and use what is learned to improve health, reduce injuries, and save lives in future disasters.

2004 2005 2006


World Trade Center Health Registry Dollars in thousands


Spending $1,740 $925 $1,265 PS 406 605 504 OTPS 1,334 320 760 Funding Federal n.a. n.a. $1,265 Full-time Positions 9 7 7SOURCE: IBO. NOTE: Full-time personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006. Performance Results: World Trade Center Health Registry Performance Statistics Type of Indicator 2002 2003 2004 2005 Total enrollment in the WTC Health Registry* Outcome n.a. n.a. 41,080 71,609 Enrollees interviewed Outcome n.a. n.a. n.a. 61,087 SOURCE: Department Of Health and Mental Hygiene. *NOTE: Registry was launched in FY 2004.



General Disease Prevention and Treatment The Division collects and analyzes data on disease trends, providing active surveillance, and educates the public and the medical community about disease prevention and treatment.

2004 2005 2006


General Disease Prevention and Treatment Dollars in thousands


Spending $998 $245 $825 PS 898 199 521 OTPS 100 46 304 Funding City n.a. n.a. $23 State n.a. n.a. 120 Federal n.a. n.a. 572 Other Categorical n.a. n.a. 111 Full-time Positions 1 5 3SOURCE: IBO. NOTE: Full-time personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006.

Performance Results: No reported performance statistics.

Department of Health and Mental Hygiene Environmental Health Services


PROGRAM AREA: ENVIRONMENTAL HEALTH SERVICES The goal of the Division of Environmental Health Services is to eliminate the incidence of injury and illness related to environmental health risks through prevention, education, and surveillance activities. Environmental Health Services 2004 2005 2006 Dollars in thousands Actual Actual Current

Expenses Expenses Modified BudgetSpending $57,093 $63,172 $73,469

Personal services 30,141 32,309 40,834Other than personal services 26,952 30,862 32,635

Funding City n.a. n.a. $52,299 Intracity n.a. n.a. 990 Federal n.a. n.a. 5,459 State n.a. n.a. 14,143 Other Categorical n.a. n.a. 361 Full-time Positions 465 494 503 Programs General Environmental Health $27,060 $31,082 $31,579Veterinary and Pest Control Services 17,533 18,836 24,196Lead Poisoning Prevention and Treatment 6,019 6,555 9,191Asthma Initiatives 3,981 4,191 3,846Environmental Sciences and Engineering 2,312 2,418 2,314Poison Control 76 22 1,999Food Safety and Community Sanitation 112 68 344SOURCE: IBO. NOTE: Full-time personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006. Performance results: See program sections.



General Environmental Health Services The Division of Environmental Health Services prevents and controls environmentally and occupationally related diseases. The Division protects New York City residents and workers with a range of services, including epidemiological assessments, community studies, consultation and technical assistance, public education, and policy development and analysis. The Division has received funding from the US Centers for Disease Control and Prevention (CDC) to develop an Environmental Public Health Tracking Program to collect and analyze data on environmental hazards and exposures.

2004 2005 2006 Actual Actual Current

General Environmental Health Dollars in thousands


Spending $27,060 $31,082 $31,579 PS 11,752 12,456 11,176 OTPS 15,308 18,625 20,404 Funding City n.a. n.a. $21,768 State n.a. n.a. 8,218 Federal n.a. n.a. 1,580 Full-time Positions 196 207 222 SOURCE: IBO. NOTE: Full-time personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006. Performance Results: General Environmental Health Services Performance Statistics Type of Indicator 2002 2003 2004 2005 Environmental health complaints Demand 21,293 31,936 39,259 50,832

SOURCES: HealthTrac, Department Of Health and Mental Hygiene.



Veterinary and Pest Control Services The Bureau of Veterinary and Pest Control Services conducts activities to protect the public from animal-borne disease, hazards, and nuisances by controlling and regulating animals. The Bureau investigates reported animal bites and conducts follow-up on biting animals that are capable of transmitting disease. The Bureau also contracts with New York City Animal Care and Control (NYCACC), a non-profit organization that operates shelters for homeless and abused animals. To prevent rodent-borne diseases and improve the quality of life of in New York City, the Bureau conducts inspections, enforcement, extermination, clean-up, and education. The Bureau also works to detect the presence of vector-borne disease pathogens and prevent the transmission of these pathogens to humans and other hosts, and focuses on preventing encephalitis, Lyme disease, Rocky Mountain spotted fever, West Nile Virus, and additional diseases borne by mosquitoes, ticks, and other arthropods.

2004 2005 2006


Veterinary and Pest Control Services Dollars in thousands


Spending $17,533 $18,836 $24,196

PS 10,101 10,348 15,266 OTPS 7,432 8,488 8,930 Funding City n.a. n.a. $20,181 State n.a. n.a. 2,864 Intracity n.a. n.a. 990 Full-time Positions 112 108 105 Service Areas General Pest Control Services $9,602 $10,737 $15,617 Animal Care and Control 7,931 8,097 8,418SOURCE: IBO. NOTE: Full-tim e personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006.

Performance Results: Veterinary and Pest Control Services Performance Statistics Type of Indicator 2002 2003 2004 2005 Pest control complaints received Demand 16,176 20,934 22,595 31,606 Inspections made in response to complaints Output 13,828 19,241 22,103 27,346 Exterminations performed Output 71,566 74,829 83,874 88,056 Properties inspected as part of citywide rodent initiative* Output n.a. n.a. 21,212 20,660 Properties failing inspection as part of citywide rodent initiative* Outcome n.a. n.a. 1,739 1,075 West Nile virus cases reported** Outcome 7 29 31 5 Animal bites reported Outcome 8,036 7,849 5,835 5,448 Dog licenses issued Output 95,121 94,353 104,633 100,576 SOURCES: Mayor’s Management Report, HealthTrac, Department Of Health and Mental Hygiene. NOTES: *Citywide rodent initiative was launched in FY ’04. ** Indicator reported on a calendar year basis.



Lead Poisoning Prevention and Treatment Founded in 1970, the Lead Poisoning Prevention Program prevents and controls childhood lead poisoning by: pursuing public and private action to prevent lead poisoning by reducing children’s exposure to lead hazards; promoting early detection of lead poisoning through screening to help prevent additional exposure; and providing services for lead-poisoned children, their families, and their health care providers.

2004 2005 2006


Lead Poisoning Prevention and Treatment Dollars in thousands


Spending $6,019 $6,555 $9,191 PS 5,065 5,926 9,136 OTPS 954 629 55 Funding City n.a. n.a. $3,931 State n.a. n.a. 1,625 Federal n.a. n.a. 3,634 Full-time Positions 96 116 116SOURCE: IBO. NOTE: Full-time personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006. Performance Results: Lead Poisoning Prevention and Treatment Performance Statistics Type of Indicator 2002 2003 2004 2005 New cases among children under 18 years old identified with blood lead levels greater than or equal to 10 micrograms per deciliter Demand 5,430 4,632 4,071 3,501 Percentage of new cases among children aged 6 months to 6 years Outcome 82.1% 80.8% 81.5% 84.0% Lead complaints received Demand 107 88 121 203 Complaints responded to (%) Output 96% 99% 98% 91% Total safety inspections conducted Output 2,001 1,351 1,200 2,571 Total safety violations issued Outcome 383 239 238 446




Asthma Initiatives The Asthma Initiative aims to reduce asthma-related illness and death in New York City by promoting asthma control in a variety of settings, including schools, communities, and health care institutions. The program promotes improved family management of asthma, state-of-the-art medical care, and community awareness of asthma, among other activities targeted to children and their families. Asthma Initiatives Dollars in thousands 2004

Actual Expenses

2005 Actual

Expenses


Spending $3,981 $4,191 $3,846 PS 879 1,155 754 OTPS 3,102 3,036 3,092 Funding City n.a. n.a. $3,459 State n.a. n.a. 355 Full-time Positions 14 18 19 SOURCE: IBO. NOTE: Full-time personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006.

Performance Results: Asthma Initiatives Performance Statistics Type of Indicator 2002 2003 2004 2005 Hospitalization rate for children aged 0-14 (per 1,000 children)* Outcome 6.2 6.0 6.5 6.1 SOURCE: Mayor’s Management Report. * NOTE: Indicator reported by calendar year, not fiscal year.



Environmental Sciences and Engineering The Bureau of Environmental Sciences and Engineering investigates, assesses, and prevents public health threats from toxic and hazardous materials, ionizing radiation, and food-borne illness, as well as monitors the quality and safety of drinking water and recreational water.

2004 2005 2006


Environmental Sciences and Engineering Dollars in thousands


Spending $2,312 $2,418 $2,314

PS 2,233 2,339 2,177 OTPS 79 79 137 Funding City n.a. n.a. $1,361 State n.a. n.a. 636 Federal n.a. n.a. 256 Other Categorical n.a. n.a. 61 Full-time Positions 45 44 40SOURCE: IBO. NOTE: Full-time personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006.

Performance Results: Environmental Sciences and Engineering Performance Statistics Type of Indicator 2002 2003 2004 2005 Initial Radiation Equipment Cycle Inspections Output 1,321 1,496 1,584 1,506




Poison Control The New York City Poison Control Center provides comprehensive services for poison prevention and treatment to all New Yorkers, 24-hours-a-day, 7-days-a-week. The Poison Control Center is the only facility that provides emergency toxicology services to emergency departments, doctors, and households in New York City. A voluntary medical support network of physician consultants provide expertise in associated toxicology fields including herpetology (reptiles), mycology (fungus), botany (plants), and environmental and occupational medicine. The Center also conducts community education to prevent poisoning. The Poison Control Center can be reached either through its hotline (212) POISONS or 311.

2004 2005 2006


Poison Control Dollars in thousands


Spending $76 $22 $1,999

PS 57 22 1,999 OTPS 19 0 0 Funding City n.a. n.a. $1,388 State n.a. n.a. $311 Other Categorical $300 Full-time Positions 1 0 0SOURCE: IBO. NOTE: Full-time personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006.

Performance Results: Poison Control Performance Statistics Type of Indicator 2002 2003 2004 2005 Calls to poison control Demand 63,466 64,260 70,036 65,601

SOURCES: HealthTrac, Department Of Health and Mental Hygiene.



Food Safety and Community Sanitation The Bureau of Food Safety and Community Sanitation conducts inspections of food service establishments, mobile food vending operations, senior centers, public schools, day camps, correctional facilities, single-room occupancy hotels, and window guard installations in multiple family dwellings.

2004 2005 2006


Food Safety and Community Sanitation Dollars in thousands


Spending $112 $68 $344 PS 54 62 327 OTPS 58 6 17 Funding City n.a. n.a. $210 State n.a. n.a. 134 Full-time Positions 1 1 1 SOURCE: IBO. NOTE: Full-time personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006.

Performance Results: Food Safety and Community Sanitation Performance Statistics Type of Indicator 2002 2003 2004 2005 Food service establishment inspections performed Output 19,207 21,781 25,045 25,819 Health Academy attendance Output 9,739 12,903 13,429 14,001 Window guard inspections performed Output 7,834 11,298 17,118 19,089

SOURCES: Mayor’s Management Report, HealthTrac, Department Of Health and Mental Hygiene.

Department of Health and Mental Hygiene Personal and Community Health Services


PROGRAM AREA: PERSONAL AND COMMUNITY HEALTH SERVICES DOHMH’s personal and community health services focus on community-oriented approaches. Personal and community health services’ core programs include: tobacco control, chronic disease prevention, neighborhood-based District Public Health Offices, school health, maternal and child health, and day care monitoring. Personal and Community Health Services 2004 2005 2006 Dollars in thousands Actual Actual Current


Spending $104,371 $123,323 $131,472 Personal services 72,863 72,765 79,470 Other than personal services 31,508 50,558 52,001

Funding City n.a. n.a. $76,456 Intracity n.a. n.a. 0 Federal n.a. n.a. 4,961 State n.a. n.a. 43,145 Other Categorical n.a. n.a. 7,079 Full-time Positions 505 531 551 Programs School Health Services $52,882 $50,762 $61,154 General Personal and Community Health Services 37,553 57,114 57,434 Day Care Monitoring 5,865 7,522 6,407 Maternal and Child Health 4,236 3,807 3,632 Tobacco Control 3,834 4,119 2,845 SOURCE: IBO. NOTE: Full-time personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006.

Performance Results: See program sections.



School Health Services The Office of School Health promotes the physical, emotional, social, and environmental health of 1.4 million schoolchildren in approximately 1,300 public and non-public schools. Services include counseling, health education, and case management that focus on identifying health problems and making referrals for ongoing treatment. School Health Services Dollars in thousands 2004

Actual Expenses

2005 Actual

Expenses


Spending $52,882 $50,762 $61,154 PS 52,882 50,762 61,154 OTPS 0 0 0 Funding City n.a. n.a. $34,983 State n.a. n.a. 19,370 Other Categorical n.a. n.a. 6,801 Full-time Positions 155 154 154 SOURCE: IBO. NOTE: Full-time personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006. Performance Results: School Health Services Performance Statistics Type of Indicator 2002 2003 2004 2005 New admission exams collected and reviewed by DOHMH school health staff Output 128,872 121,027 110,324 112,669 New admission exams performed by DOHMH school health staff Output 541 n.a. 15,511 12,236




General Personal and Community Health Services Generally, DOHMH’s personal and community health service programs promote healthy behaviors to prevent and control chronic diseases, such as diabetes, heart disease, and cancer. The Bureau of Chronic Disease’s approach to this task includes a broad focus on biological, psychological, social, and environmental issues. DOHMH has established three District Public Health Offices in high-risk neighborhoods—the South and East Bronx, East and Central Harlem, and North and Central Brooklyn. In each community, the District Public Health Office coordinates and monitors existing public health programs; expands collaboration with other city and state agencies; develops joint projects with community-based organizations, hospitals, and clinics to improve health; and ensures that community residents know where to get health care services and information.

2004 2005 2006


General Personal and Community Health Dollars in thousands


Spending $37,553 $57,114 $57,434

PS 9,282 9,671 7,566 OTPS 28,271 47,443 49,867 Funding City n.a. n.a. $36,627 State n.a. n.a. 20,326 Federal n.a. n.a. 372 Other Categorical n.a. n.a. 279 Full-time Positions 141 140 141 SOURCE: IBO. NOTE: Full-time personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006.

Performance Results: General Personal and Community Health Services Performance Statistics Type of Indicator 2002 2003 2004 2005 Adults, aged 50+, who received a colonoscopy in the past 10 years (%)* Outcome n.a. n.a. 42.0% 52.2% SOURCE: Mayor’s Management Report. *NOTE: Indicator statistics available only for FY 2004 and 2005; indicator was a new initiative in 2004.



Day Care Monitoring As the regulatory agency for both public and private child-care services, the Bureau of Day Care regulates day-care programs conducts site visits to determine compliance with city and state regulations. The Bureau also receives and investigates complaints regarding day care center operations.

2004 2005 2006


Day Care Monitoring Dollars in thousands


Spending $5,865 $7,522 $6,407

PS 5,665 6,946 5,677 OTPS 201 576 730 Funding City n.a. n.a. $1,399 State n.a. n.a. 614 Federal n.a. n.a. 4,393 Full-time Positions 124 156 169 SOURCE: IBO. NOTE: Full-time personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006.

Performance Results: Day Care Monitoring Performance Statistics Type of Indicator 2002 2003 2004 2005 Total day care services known to DOHMH at end of FY Demand 19,736 14,381 12,784 11,715 Group day care permits issued Output 1,426 1,554 1,410 1,482 Family day care and group family day care permits issued Output 3,289 3,676 3,780 3,712 Day care site complaints received Demand n.a. n.a. 1,052 1,435




Maternal and Child Health Services The Bureau of Maternal, Infant and Reproductive Health promotes the health of women and their infants and families in New York City. The Bureau’s goals are to reduce infant and maternal mortality, prevent unintended pregnancies (which account for more than half of all pregnancies in New York City), and eliminate disparities in prenatal and reproductive health. The Bureau addresses these critical public health issues through outreach, community and provider education, demonstration and dissemination of evidence-based interventions, surveillance, surveys, case reviews of infant and maternal deaths, community- based strategic planning, and program implementation.

2004 2005 2006


Maternal and Child Health Dollars in thousands


Spending $4,236 $3,807 $3,632 PS 3,288 3,078 3,615 OTPS 948 729 16 Funding City n.a. n.a. $2,112 State n.a. n.a. 1,324 Federal n.a. n.a. 195 Full-time Positions 60 52 49 SOURCE: IBO. NOTE: Full-time personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006.

Performance Results: Maternal and Child Health Services Performance Statistics Type of Indicator 2002 2003 2004 2005 Infant mortality rate (per 1,000 live births)* Outcome 6.0 6.5 6.1 n.a. Calls to women’s healthline Output 26,945 22,995 10,296 8,919 Initial prenatal care appointments made within 3 weeks of initial contact Output 698 787 n.a. n.a. Percentage of initial prenatal care appointments kept Outcome 77% 59% n.a. n.a. SOURCE: Mayor’s Management Report. *NOTE: Indicator reported on a calendar year basis.



Tobacco Control Tobacco kills 10,000 New Yorkers each year and is the leading cause of preventable death in New York City. Stopping the epidemic of tobacco use is a top priority at DOHMH. The Tobacco Control Program addresses this epidemic through education, smoking-cessation programs, legal action, taxation, and evaluation of policies and activities.

2004 2005 2006


Tobacco Control Dollars in thousands


Spending $3,834 $4,119 $2,845 PS 1,746 2,308 1,457 OTPS 2,088 1,811 1,388 Funding City n.a. n.a. $1,335 State n.a. n.a. 1,510 Full-time Positions 27 31 38 SOURCE: IBO. NOTE: Full-time personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006.

Performance Results: Tobacco Control Performance Statistics Type of Indicator 2002 2003 2004 2005 Adults who smoke (%)* Outcome 21.5% 19.2% 18.4% n.a. SOURCE: Mayor’s Management Report. *NOTE: Indicator reported on a calendar year basis.

Department of Health and Mental Hygiene Health Insurance and Health Care Access


PROGRAM AREA: HEALTH INSURANCE AND HEALTH CARE ACCESS The Division of Health Insurance and Health Care Access promotes the availability of quality health care services in New York City through Medicaid managed care and other insurance programs. The Division creates mechanisms to promote access to quality health care for the uninsured and underinsured, oversees and evaluates health insurance programs and health services to ensure maximum access to quality services for targeted populations, including those with special needs, and promotes awareness and understanding of available health services. The Division also provides medical care to incarcerated populations through its Office of Correctional Health Services. Finally, the Division’s Office of Oral Health provides oral health care to populations that might otherwise lack access to dental services. Health Insurance and Health Care Access 2004 2005 2006 Dollars in thousands Actual Actual Current

Expenses Expenses Modified Budget Spending $156,311 $154,855 $156,880

Personal services 12,472 13,891 19,097 Other than personal services 136,694 133,816 129,582

Funding City n.a. n.a. $134,151 State n.a. n.a. 16,574 Federal n.a. n.a. 1,841 Intracity n.a. n.a. 4,314 Full-time Positions 299 307 311 Programs Correctional Health Services $135,379 $135,848 $133,376 Health Insurance and Medicaid Managed Care 13,787 11,860 15,303 Oral Health Services 7,145 7,147 8,201 SOURCE: IBO. NOTE: Full-time personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006. Performance Results: See program section.



Correctional Health Services There are more than 100,000 admissions to the New York City prison system each year. DOHMH has responsibility for managing correctional health services for the City of New York, providing comprehensive medical, mental health, and dental services to inmates in the city’s correctional facilities. Given the high rates of HIV infection, tuberculosis, sexually-transmitted diseases, psychiatric problems, and substance abuse in this population, these services are critical. Correctional Health Services provides both directed and contracted services for medical visits, dental visits, and mental health visits for patients in correctional facilities.

2004 2005 2006


Correctional Health Services Dollars in thousands


Spending $135,379 $135,848 $133,376 PS 8,108 9,732 12,975 OTPS 127,271 126,116 120,401 Funding City n.a. n.a. $122,152 State n.a. n.a. 11,146 Federal n.a. n.a. 78 Full-time Positions 154 170 178 SOURCE: IBO. NOTE: Full-time personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006.

Performance Results: Correctional Health Services Performance Statistics Type of Indicator 2002 2003 2004 2005 Direct Services Medical visits Output 96,872 83,045 36,541 44,269 Mental health visits Output 13,509 15,983 5,377 5,712 Dental visits (initial) Output 3,696 2,613 967 1,485

Contracted Services Medical visits Output 372,041 644,562 715,602 778,465 Mental health visits Output 283,581 188,397 190,436 210,270 Dental visits (initial) Output 13,267 15,184 15,347 11,985




Health Insurance and Medicaid Managed Care The Division administers and monitors Medicaid managed care plans, which deliver health care services to most Medicaid beneficiaries in New York City. The Division executes contractual agreements with managed care plans, monitors the performance of these plans, and enforces the terms of the contracts.

2004 2005 2006


Health Insurance and Medicaid Managed Care Dollars in thousands


Spending $13,787 $11,860 $15,303

PS 4,364 4,160 6,122 OTPS 9,423 7,700 9,181 Funding City n.a. n.a. $6,477 State n.a. n.a. 2,749 Federal n.a. n.a. 1,762 Intracity n.a. n.a. 4,314 Full-time Positions 68 69 64 SOURCE: IBO. NOTE: Full-time personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006.

Performance Results: Health Insurance and Medicaid Managed Care Performance Statistics Type of Indicator 2002 2003 2004 2005 Medicaid Managed Care Enrollment Outcome 666,744 1,116,601 1,362,061 1,472,868




Oral Health Services The Bureau of Oral Health promotes the oral health of New York City residents through the prevention and control of oral diseases. To expand its reach, the Bureau partners with academic institutions, private corporations, and dental organizations. One such partnership is with Colgate-Palmolive’s Bright Smiles, Bright Futures Mobile Dental Program, through which oral screening, education and referral activities are extended far beyond the Bureau’s 43 dental clinics citywide. These clinics provide comprehensive dental treatment for children and adolescents. The Bureau also provides free oral cancer screenings throughout the city in conjunction with the Oral Cancer Consortium.

2004 2005 2006


Oral Health Services Dollars in thousands


Spending $7,145 $7,147 $8,201

PS 5,765 6,292 6,716 OTPS 1,380 855 1,485 Funding City n.a. n.a. $5,522 State n.a. n.a. 2,679 Full-time Positions 77 68 69 SOURCE: IBO. NOTE: Full-time personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006.

Performance Results: Oral Health Services Performance Statistics Type of Indicator 2002 2003 2004 2005 Dental visits Outcome 56,053 59,296 57,492 66,589


Department of Health and Mental Hygiene Mental Health


PROGRAM AREA: MENTAL HEALTH The mission of the Division of Mental Hygiene is to improve access to, and enhance the quality and effectiveness of, mental hygiene services for New Yorkers. The Division carries out its mission through the following activities: planning, funding, developing, certifying, and overseeing programs and services designed to meet consumers’ needs and improve the lives of New Yorkers; monitoring the quality of programs under contract with DOHMH to ensure their effectiveness; conducting health promotion activities, crisis intervention, and training; and providing public education to promote the availability of mental health, developmental disability, and chemical dependency services. The Division of Mental Hygiene also prepares and disseminates information on a range of mental hygiene issues. Mental Health 2004 2005 2006 Dollars in thousands Actual Actual Current

Expenses Expenses Modified BudgetSpending $768,494 $714,811 $809,289


Funding City n.a. n.a. $221,428 State n.a. n.a. 337,436 Federal n.a. n.a. 23,955 Other Categorical n.a. n.a. 225,917 Federal Community Development Funds n.a. n.a. 553 Full-time Positions 129 118 119 Programs Early Intervention Program $520,183 $464,182 $553,806General Mental Health 208,896 206,561 212,575Chemical Dependency Prevention and Treatment 39,415 44,068 42,908SOURCE: IBO. NOTE: Full-time personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006.

Performance Results: Key Performance Measures Type of

Indicator

2002

2003

2004

2005 Total number of contracts with voluntary agencies for mental health services Demand 373 365 346 358 Fiscal audits on voluntary agencies completed Output

377 449 277 380

Comprehensive program audits completed Output

514 446 465 426

Unannounced site visits Output

362 345 322 330 Contracts canceled due to evaluation or audit Outcome 0 0 0 0 SOURCE: Mayor’s Management Report.



Early Intervention Program The Early Intervention Program (EIP) offers evaluation and services for infants and toddlers up to 3 years old who have developmental delays. Prompt intervention in the first 3 years of a child’s life can greatly increase a child’s ability to reach his or her full potential. The EIP offers therapeutic services including speech, occupational, and physical therapy; special instruction; nutrition services; nursing services; and service coordination. Many of these services are provided at home as well as in neighborhood facilities.

2004 2005 2006


Early Intervention Program


Spending $520,183 $464,182 $553,806

PS 213 327 343 OTPS 519,970 463,855 553,463 Funding City n.a. n.a. $152,961 State n.a. n.a. 172,031 Federal n.a. n.a. 3,000 Other Categorical n.a. n.a. 225,814 Full-time Positions 6 6 6 SOURCE: IBO. NOTE: Full-time personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006.

Performance Results: Early Intervention Program Performance Statistics Type of Indicator 2002 2003 2004 2005 Children referred to Early Intervention* Demand n.a. n.a. 23,105 23,599 Children evaluated Output n.a. n.a. 20,079 21,246 Children found eligible Outcome n.a. n.a. 17,491 18,360 Children for whom an initial service plan is developed Output n.a. n.a. 15,877 16,001 Children with active service plans at end of year Outcome n.a. n.a. 19,426 17,618 SOURCE: Mayor’s Management Report. *NOTE: Indicator now provided on a calendar year basis.



General Mental Health Services Through contracts with provider agencies, the Division of Mental Hygiene provides a variety of mental health services to New York City residents. LifeNet, a toll-free, 24-hour confidential hotline that provides free mental health information and referral services, has had a long-term relationship with the DOHMH. Operated by the Mental Health Association of New York City and funded by DOHMH, hotline services are available in English, Spanish, and Chinese, with services in other languages available upon request. The Division also contracts for mental health services aimed specifically at children and adolescents as well as contracts for adults with mental retardation and developmental disabilities (MRDD). Services provided to MRDD individuals include: medical and clinical services, vocational programs, work readiness and transitional employment programming, family support, senior day-care programs, home services, counseling, and continuing education.

2004 2005 2006


General Mental Health Services Dollars in thousands


Spending $208,896 $206,561 $212,575

PS 6,419 5,783 6,843 OTPS 202,477 200,777 205,732 Funding City n.a. n.a. $49,046 State n.a. n.a. 141,918 Federal n.a. n.a. 20,955 Other Categorical n.a. n.a. 103 Federal Community Development Funds n.a. n.a. 553 Full-time Positions 123 112 113 SOURCE: IBO. NOTE: Full-time personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006.

Performance Results: General Mental Health Services Performance Statistics Type of Indicator 2002 2003 2004 2005 Calls to LifeNet Outcome 60,900 87,700 70,300 67,600 Individuals served through Project Liberty (cumulative) Outcome 197,700 709,700 1,223,500 1,492,100 Units of supportive housing available to persons with diagnosis of severe mental illness Output 10,700 11,100 11,500 12,500




Chemical Dependency Prevention and Treatment The Division of Mental Hygiene develops, contracts, and monitors chemical dependency prevention and treatment services throughout New York City. Core goals with respect to chemical dependency services are to: monitor chemical dependency services delivered by voluntary agencies, hospitals, community-based organizations, and the New York City Health and Hospitals Corporation; promote public awareness about the harmful consequences of alcohol and drug use; and provide information about alcohol and substance abuse prevention and treatment services citywide.

2004 2005 2006


Chemical Dependency Prevention and Treatment Dollars in thousands


Spending $39,415 $44,068 $42,908

PS 0 0 0 OTPS 39,415 44,068 42,908 Funding City n.a. n.a. $19,420 State n.a. n.a. 23,487 Full-time Positions 0 0 0 SOURCE: IBO. NOTE: Full-time personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006.

Performance Results: Chemical Dependency Prevention and Treatment Performance Statistics Type of Indicator 2002 2003 2004 2005 Deaths due to drug abuse* Outcome 905 960 849 n.a. SOURCE: Mayor’s Management Report. *NOTE: Indicator reported on a calendar year basis.

Department of Health and Mental Health Office of The Chief Medical Examiner

PROGRAM AREA: OFFICE OF THE CHIEF MEDICAL EXAMINER The Office of Chief Medical Examiner investigates cases of persons who die within New York City from criminal violence; by casualty or by suicide; suddenly, when in apparent good health; when unattended by a physician; in a correctional facility; or in any suspicious or unusual manner. The Office also investigates when an application is made pursuant to law for a permit to cremate the body of a person. The Office provides additional forensic services, including DNA testing, to support criminal investigations. The Office also manages all functions of the City mortuary, including the retrieval and processing of deceased bodies, assistance with autopsies, and body preparation for City burial. Office of the Chief Medical Examiner 2004 2005 2006 Dollars in thousands Actual Actual Current

Expenses Expenses Modified Budget Spending $39,352 $39,395 $50,129


Funding City n.a. n.a. $36,777 State n.a. n.a. 8,102 Federal n.a. n.a. 5,250 Full-time Positions 386 408 427SOURCE: IBO. NOTE: Full-time personnel: June 30 actual for 2002 through 2005; as of November 30 for 2006.

Performance Results: Key Performance Measures Type of

Indicator

2002

2003

2004

2005 Deaths reported Demand 23,510 23,311 25,240 25,702 Deaths certified by OCME Outcome 8,883 8,932 8,820 8,727 Scene visit cases Output 4,529 7,975 5,988 3,247 Average time from receipt of body to time body ready for release (hours) Efficiency 17.6 18 18 20 External examinations completed Output 2,260 2,416 1,766 2,097 Autopsies completed Output 5,507 5,472 5,642 5,120 Percentage of death certificates issued within four hours of autopsy completion Output 93% 95% 89% 88% Average days from autopsy to completion of autopsy report Efficiency 80 97 77 n.a. Percentage of autopsy reports completed within 90 days Efficiency 67% 69% 72% 72% Average time to complete a forensic DNA case (days) Efficiency 40 49 67 68 Average time to complete a forensic toxicology case (days) Efficiency 30 27 18 20 Sexual assault cases (non-fatality) completed within 30 days using forensic DNA testing (%) Efficiency 17% 47% 19% 29% DNA matches with profiles in database Outcome 163 1,465 470 352 SOURCE: Mayor’s Management Report.

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